Sustainability of Change: Evaluating Febrile Neutropenia Process in Pediatric Setting

2.50
Hdl Handle:
http://hdl.handle.net/10755/623651
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Sustainability of Change: Evaluating Febrile Neutropenia Process in Pediatric Setting
Author(s):
Childress, Jennifer; Asher, Kelly; Jones, Angela; King, Amber; Maloney, Lisa; Monroe, Kathy; Thompson, Stephanie
Lead Author STTI Affiliation:
Non-member
Author Details:
Jennifer Childress, BSN, RN, CPEN; Kelly Asher, RN; Angela Jones BSN, RN; Amber King, BSN, RN, CPEN; Lisa Maloney, MSN, RN; Kathy Monroe, MD; Stephanie Thompson, RN
Abstract:

Poster presentation

Session A presented Thursday, September 14, 2017

Purpose: Febrile neutropenia is considered an oncologic emergency.  It has been shown that decreasing the door-to-antibiotic time for this population positively effects patient outcomes. A pathway was created to improve time to antibiotics (TTA) in a pediatric ED and this project evaluated efforts to sustain this quality improvement initiative.

Design: A quality improvement project including a multi-disciplinary team evaluating data, staff perceptions, and brainstorming innovative ways to sustain change.

Setting: 53-bed level 1 urban pediatric trauma center with approximately 72,000 visits annually.

Participants/Subjects: Immunosuppressed patients of any age, with oncologic/hematologic suppression were included. Transplant patients were excluded. In 2016, we expanded to include any patient followed by Hematology/Oncology for any possible neutropenia.

Methods: Over the course of several years, the Febrile Neutropenia Pathway was updated and monitored. The multi-disciplinary project team included physicians, Oncology providers, emergency department (ED) educators, pharmacy staff, and ED nurses. The pathway was agreed upon by the project team and in late 2011/early 2012 and phase 1 was initiated in the electronic medical record (EMR) using ordersets for central access and obtaining laboratory specimens rapidly to help providers ascertain if patients were neutropenic. Data was monitored quarterly for meeting goals and real time open record review for "just in time training" was used. Data monitored was percent of patient population who received antibiotics in less than 61 minutes from arrival (goal being 90%). In early 2012, phase 2 included agreed upon antibiotic to be used for one time dosing regardless of lab studies. In August 2012, with a move to new facility, compliance percentage fell drastically. After a team Gemba walk in quarter 1, 2013, the non-value adding steps were addressed by organization of supplies into "kits" and pharmacy begain mixing one time doses of Cefepime (phase 3). In quarter 2, 2014, the EMR was changed and the ability to obtain data was greatly hampered; the project team went on hiatus until early 2016. Phase 4 began in 2016 and the project team isolated two metrics for accountability, conducted a literature review, used staff interviews, chart reviews, and Gemba walks to assess the problem. Unit champions began discussing the data points and presenting them to staff in graphical format. This led to improvement, however, staff engagement and understanding remained a low so "scorecards" were posted in staffing areas. Making this project routine for staff and providing accountability to staff has improved our compliance percentages.

Results/Outcomes: Original baseline data shows a compliance rate of 35% which was only improved to 54% meeting the goal at its peak prior to final intervention. Early data at this point shows tremendous improvement (up to 91% with TTA < 61 mins) and both goals were obtained for the first time.

Implications: Sustainablility of change remains a large issue for our institution. Using precepts from the ELIAS Performance Management Framework, we chose to put accountability and routinization at the forefront of our process to affect change and sustain that change over time. This project has areas that are easily adapted for other performance improvement initiatives to ensure long-lasting change.

Keywords:
Door-to-antibiotic Time; Febrile Neutropenia; Emergency Department
Repository Posting Date:
4-Dec-2017
Date of Publication:
4-Dec-2017
Conference Date:
2017
Conference Name:
Emergency Nursing 2017
Conference Host:
Emergency Nurses Association
Conference Location:
St. Louis, Missouri, USA
Description:
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleSustainability of Change: Evaluating Febrile Neutropenia Process in Pediatric Settingen_US
dc.contributor.authorChildress, Jenniferen
dc.contributor.authorAsher, Kellyen
dc.contributor.authorJones, Angelaen
dc.contributor.authorKing, Amberen
dc.contributor.authorMaloney, Lisaen
dc.contributor.authorMonroe, Kathyen
dc.contributor.authorThompson, Stephanieen
dc.contributor.departmentNon-memberen
dc.author.detailsJennifer Childress, BSN, RN, CPEN; Kelly Asher, RN; Angela Jones BSN, RN; Amber King, BSN, RN, CPEN; Lisa Maloney, MSN, RN; Kathy Monroe, MD; Stephanie Thompson, RNen
dc.identifier.urihttp://hdl.handle.net/10755/623651-
dc.description.abstract<p>Poster presentation</p> <p>Session A presented Thursday, September 14, 2017</p> <p>Purpose: Febrile neutropenia is considered an oncologic emergency.&nbsp; It has been shown that decreasing the door-to-antibiotic time for this population positively effects patient outcomes. A pathway was created to improve time to antibiotics (TTA) in a pediatric ED and this project evaluated efforts to sustain this quality improvement initiative.</p> <p>Design: A quality improvement project including a multi-disciplinary team evaluating data, staff perceptions, and brainstorming innovative ways to sustain change.</p> <p>Setting: 53-bed level 1 urban pediatric trauma center with approximately 72,000 visits annually.</p> <p>Participants/Subjects: Immunosuppressed patients of any age, with oncologic/hematologic suppression were included. Transplant patients were excluded. In 2016, we expanded to include any patient followed by Hematology/Oncology for any possible neutropenia.</p> <p>Methods: Over the course of several years, the Febrile Neutropenia Pathway was updated and monitored. The multi-disciplinary project team included physicians, Oncology providers, emergency department (ED) educators, pharmacy staff, and ED nurses. The pathway was agreed upon by the project team and in late 2011/early 2012 and phase 1 was initiated in the electronic medical record (EMR) using ordersets for central access and obtaining laboratory specimens rapidly to help providers ascertain if patients were neutropenic. Data was monitored quarterly for meeting goals and real time open record review for "just in time training" was used. Data monitored was percent of patient population who received antibiotics in less than 61 minutes from arrival (goal being 90%). In early 2012, phase 2 included agreed upon antibiotic to be used for one time dosing regardless of lab studies. In August 2012, with a move to new facility, compliance percentage fell drastically. After a team Gemba walk in quarter 1, 2013, the non-value adding steps were addressed by organization of supplies into "kits" and pharmacy begain mixing one time doses of Cefepime (phase 3). In quarter 2, 2014, the EMR was changed and the ability to obtain data was greatly hampered; the project team went on hiatus until early 2016. Phase 4 began in 2016 and the project team isolated two metrics for accountability, conducted a literature review, used staff interviews, chart reviews, and Gemba walks to assess the problem. Unit champions began discussing the data points and presenting them to staff in graphical format. This led to improvement, however, staff engagement and understanding remained a low so "scorecards" were posted in staffing areas. Making this project routine for staff and providing accountability to staff has improved our compliance percentages.</p> <p>Results/Outcomes: Original baseline data shows a compliance rate of 35% which was only improved to 54% meeting the goal at its peak prior to final intervention. Early data at this point shows tremendous improvement (up to 91% with TTA &lt; 61 mins) and both goals were obtained for the first time.</p> <p>Implications: Sustainablility of change remains a large issue for our institution. Using precepts from the ELIAS Performance Management Framework, we chose to put accountability and routinization at the forefront of our process to affect change and sustain that change over time. This project has areas that are easily adapted for other performance improvement initiatives to ensure long-lasting change.</p>en
dc.subjectDoor-to-antibiotic Timeen
dc.subjectFebrile Neutropeniaen
dc.subjectEmergency Departmenten
dc.date.available2017-12-04T19:14:49Z-
dc.date.issued2017-12-04-
dc.date.accessioned2017-12-04T19:14:49Z-
dc.conference.date2017en
dc.conference.nameEmergency Nursing 2017en
dc.conference.hostEmergency Nurses Associationen
dc.conference.locationSt. Louis, Missouri, USAen
dc.descriptionENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missourien
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